Factors Associated With Left Atrial Remodeling in the General Population

Abstract

Background While contributors to remodeling of the left ventricle (LV) have been well studied in general population cohorts, few data are available describing factors influencing changes in left atrial (LA) structure. Methods and Results Maximum LA volume was determined by cardiac magnetic resonance imaging (cMRI) among 748 participants in the Dallas Heart Study at two visits a mean of 8 years apart. Associations of changes in LA volume (Δ LAV) with traditional risk factors, biomarkers, LV geometry and remodeling by cMRI, and detailed measurements of global and regional adiposity (by MRI and Dual-energy x-ray absorptiometry [DEXA]) were assessed using multivariable linear regression. Greater Δ LAV was independently associated with Black and Hispanic Race/Ethnicity, Δ systolic blood pressure, LV mass and Δ LV mass, NT-proBNP and Δ NT-proBNP and BMI (p< 0.05 for each). In subanalyses, the associations of ΔLAV with LV mass parameters were driven by associations with baseline and Δ LV end diastolic volume (p<0.0001 for each) and not wall thickness (p=0.21). Associations of ΔLAV with BMI were explained exclusively by associations with visceral fat mass (p=0.002), with no association seen between ΔLAV and subcutaneous abdominal fat (p=0.47) or lower body fat (p=0.30). Conclusions Left atrial dilatation in the population is more common in Black and Hispanic than white individuals, and is associated with parallel changes in the left ventricle. LA dilatation may be mediated by blood pressure control and the development of visceral adiposity.

Metabolic syndrome associates with left atrial dysfunction

“…Waist and VAT were better predictors of LA dysfunction than BMI thus emphasizing the role of visceral obesity in LA remodeling respectively as earlier reported in LV remodeling [5]. In a recent population-based study, LA enlargement was associated with visceral obesity, but LA function was not evaluated [22]. In our study, liver fat was also associated with lower LA EF, but correlation did not remain significant after adjusting for age.…”

Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

“…Given the expanding role of the left atrium as a prognostic marker in many cardiovascular diseases, we believe that a deep understanding of LA remodelling determinants would be of paramount clinical importance in order to identify the source of the heightened risk of HF and mortality associated in this population . Our results might suggest considering even a mild degree of MR which is, on the opposite, often neglected in clinical practice.…”

Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction

“…LA enlargement correlates with epicardial fat thickness 90 and visceral fat mass. 91 In patients undergoing AF ablation (n = 236), low-voltage areas suggestive of atrial fibrosis were much more common (46% of patients) in patients with metabolic syndrome than in those without (8% 92 ). The pathomechanisms of atrial remodelling in metabolic syndrome are unclear and, as in ventricular metabolic remodelling, may be multifactorial including inflammation, oxidative stress, pro-fibrotic pathways, and others.…”